Abstract

To the editor: I appreciate the enlightenment that Harlan and associates (1) have provided with their article on congestive failure. Their data provide the beginnings of a rational, quantified framework for making clinical decisions about congestive failure.

If one accepts the authors' criterion for congestive failure (left end diastolic pressure greater than 15 mm Hg), one must conclude that the medical community habitually underdiagnoses congestive failure, since the most sensitive objective indicator (cardiomegaly) is false-negative 38% of the time. However, this conclusion depends on the validity of the authors' criterion for congestive failure. The fact that only 66% of these